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Demystifying Dementia: Understanding the Journey
136 Plays8 months ago
This episode will delve into the importance of debunking the myths and presenting the facts about dementia. Check us out as we discuss the ins-outs of dementia, lead by our very own Dr. Chris.
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Transcript
Introduction & Host Updates
00:00:18
Speaker
Hey, welcome to another episode. So I'm here with my two lovely co-hosts, Amy Jo MD. What's up y'all? And Dr. Chris. Hello guys. As y'all know, Dr. Sunshine had a wonderful baby boy, so she will not be joining us for this episode, but she will be back soon. So we decided to give her a little break, a little mommy break, and she'll be back with us very soon.
00:00:46
Speaker
We are the Chocolate MDs. And the name of this podcast is Chocolate with a Side of Medicine. Dr. No is one of your lovely hosts, but she's been out here in these streets working real hard, pulling all these night shifts. So forgive her because, you know, we got her out here, you know,
Challenges in Medicine
00:01:00
Speaker
out of her element. Normally she's either asleep or working right now. So there's that.
00:01:05
Speaker
Yeah, it's been a rough couple of days. I just know last night we admitted about 50 people between three of us. Oh, wow. I was had a mini stroke at the end of my shift. So wow. Well, I don't miss those days either. No, but the thing is, as like residents, we didn't have the technology that all these attendings had access to and did not share with us. Like dragon dictation, for one thing is
00:01:35
Speaker
Literally I can write it or I can dictate it now in literally like five minutes as a little baby intern. I remember it took me an hour to do like a history and physical, but you know, it's a time that you shoot, you shoot through that in about five minutes. You're onto the next one. It's, it's great.
00:01:51
Speaker
I love it. That is true. Oh, I don't miss that. That's true. I love my dragon. I dictate a lot. Well, my Southern draw has kicked in, too. So sometimes I'm like, that's not what
Accents & Language Evolution
00:02:01
Speaker
the hell I said. If you don't remove that, scratch that, please.
00:02:10
Speaker
It's gone. It's gone. Yeah. Don't be fooled by this podcast. Y'all don't be fooled by this podcast. I'm country. I am as country as it comes these days. Okay. Okay. So I will fight with my family members because they tell me that now I, now I talk with a draw and I'm like, no, I don't. I'm from New York. They're like, you got a draw now.
00:02:29
Speaker
I'm like, no, I don't. I fight with them. Yeah. Yeah. When I go back to Chicago, they say the same thing. But I think they can hear the slide. I mean, I do have a draw. I know I do. But here, it doesn't sound like it, right? So here where we are, they don't hear it. But when I go back to Chicago, any draw, they're like,
00:02:47
Speaker
you, oh my God, you got to act in already. And so, and it gets worse, right? So keep in mind, you know, I spent some time in Alabama, right? So when I talk to my friends, you will know who I'm on the phone with. If I'm on the phone with my friends from Alabama, you can hear it because it gets deep, right? So, you know, and I think acts like my, you know, my family's from Mississippi.
00:03:11
Speaker
background, y'all. And if you spend enough time in the South, Mississippi accents sound a little different to me than Alabama accents, which sound a little different to me than South Carolinian accents. Actually, the closer we get towards the East Coast, depending on who you're talking to in South Carolina, they sound a little Creole New Yorkish is the best way. I can explain it. It's a little bit of a hybrid.
00:03:39
Speaker
And so, you know, you just kind of get used to them. But, uh, yeah, it's a, it's an interesting, uh, it's a me and Mississippi, Alabama, Louisiana usually sound the same, but then like a lot of my family is in Georgia and I can like, I can pick up the difference between my Alabama family and my Georgia family. Um, it was very, the distinction is very clear there.
00:04:03
Speaker
But family reunions are always great because we all get together. So my Alabama folks, I'm like, I love y'all, but sometimes I just can't understand you guys.
00:04:14
Speaker
Very different. I love it. I love the southern drone, the accent, but man, it got a slow down for me a little bit because, yeah, my Midwest. Also the geechie here. So, you know, the geechie have their own, you know, so the geechie. And I think, I think that sometimes when I'm hearing what sounds to me a lot like Creole, New Orleans is more geechie than anything. And so you kind of hear, you hear a lot of it, but there's a difference, right? If you, if you ask people to spend some time in the South,
00:04:41
Speaker
Mississippi, Alabama, Georgia sound different. South Carolina sounds different. You know what's funny? I was, well it's not funny, it's interesting. I follow, I'm gonna get his name wrong and so I'm not gonna even attempt to do it. If I remember it, I will let y'all know. But I follow this guy on Instagram. Black guy, he's a, I might be getting it wrong. He's a Harvard professor, but I think he's a linguist.
00:05:08
Speaker
And they talk about the Southern draw, right? Because when we kind of mock Southern draw, like in movies and stuff like that, it's kind of associated with like a lower IQ and everything. And the irony is, is that what they were talking about is that the Southern draw
00:05:25
Speaker
It's closer to, it's a slowed down British accent or a slowed down European accent. So actually it's closer to the original language of like the people who brought us over, the slave traders and everything. It's just, as it got slowed down, it sounds like a Southern draw.
00:05:43
Speaker
versus if you sped it up. I can't remember where it is. Somebody's gonna post it. I know one of y'all know I'm talking about. So if you Google it and you find it, just give it to me, please. But if you speed it up, it actually turns into what we call a British accent.
Accents Across the U.S.
00:05:57
Speaker
Isn't it interesting? That is interesting. I would have never thought that. I know. Somebody could have been blowing smoke up my cheeks, but I was like... But you know what? I'm gonna take it. It sounds cool. I need to get a recording and just do it on two times speed and see what it sounds like. They did, right? They did. They literally sped it up and I was like, okay, that's pretty cool.
00:06:22
Speaker
That is cool. I would have never thought that. We do not have that many variation in our accents. There's like an island, Ohioan, Minnesotian, Michigander, and Chicagoan accents. That's about it. Yeah. I could be wrong if y'all want to speak, but a Midwest accent, I think it sounds the same across the board. It does. It's very beige.
00:06:49
Speaker
It sounds so boring. I think because the Midwestern accent kind of became the standard
Public Figures & Health Challenges
00:06:57
Speaker
language. So it kind of got stripped of any real flair. And it's designed to be kind of like unseasoned.
00:07:08
Speaker
a little bit. But I think when you go to the Midwest and you go into communities and you go into the hoods, you hear the different nuances in the Midwest. I don't think a Midwestern accent is the language that you hear all the time. I think the Midwestern accent is the most generic form. It's kind of this really stripped down version of what people talk
00:07:35
Speaker
if you actually saw all of Michigan or you saw all of Illinois, like you would hear differences because they do have a, you know, their version of a twang. I think you can hear the differences between that, but the Midwestern accent that they talk about traditionally sounds like the thing that you hear on TV and everything. Like it's kind of just great playing. Yeah. Right. And then like also with the, you know, the great migration, at least within the African-American community, like we have all those,
00:08:03
Speaker
influences coming up from the south so some of that southern twang is still in like at least in the vernacular of afro-americans that come up to the to the midwest like detroit or chicago um but you know for the most part yeah the midwest accent is pretty boring which i i get it it's fine yeah
00:08:37
Speaker
Two years worth of training topics since we lost. Indeed. So I think I'm going to do two today because the second one is going to tie into the main topic that Dr. Chris is doing today. So the first one is literally within the past like week. As you guys all know, the Princess of Wales, Kate Middleton, came out with her cancer diagnosis.
00:09:03
Speaker
So as we all know, you know, we, we actually highlighted this on a past episode of like the, we're seeing a lot of these types of cancers or cancers in general pop up in a younger people of the younger generation, which is a little bit alarming. So we're trying to like figure out kind of the risk factors and, you know, things that are causing that to happen. So we don't know what type of cancer Kate Middleton had. There's a lot of,
00:09:34
Speaker
Um, there's a lot of speculation about, you know, could this have been a colon cancer? Um, remember she had a colostomy bag or possible ovarian cancer, but we really don't know much. Um, that is her privacy. It's for her to want to share that information. And there's just so much speculation out there about what really happened, you know, but at the, at the most for respecting the wishes of the Royal family to, if they want to disclose that information, then they can do that. But I was just surprised to see like.
00:10:04
Speaker
I mean, it almost kind of puts in perspective, like, it doesn't matter if you are the princess of or duchess duchess princess. She does she still? I don't know. Man, I thought she was princess. I can't keep up. I watched all this British and Ali I should know this but um, yeah, her rank it doesn't matter what rank you are in society you are all we are all susceptible to
00:10:33
Speaker
all these different risks. She's still the princess of whales. Pretty sure she's still a princess of whales. Yeah, so it's just like, it's kind of, it just puts into perspective about, you know, you're still at risk of all these, these different cancers and whatnot. And just to see that this person, this really high profile person has this type of cancer, preventable or not, we don't know yet. You know, it's just kind of
00:10:58
Speaker
It's a little nerve wracking. So I don't know if you guys saw that and
Weight Loss & Public Perception
00:11:02
Speaker
had any additional thoughts on it. I mean, you know, I was following, I kind of follow, I was following because, you know, before she said it, there were all kind of rumors flying like, is she dead? Who kidnapped her? Like, you know, is there a cheating scandal? Like all these things. And so, um, I,
00:11:23
Speaker
One, I agree. I wish the princess nothing but full recovery, health, wealth, all those things. So that's gotta be hard. And they speculated so much that you could even have a private moment to gather your thoughts because people were declaring you deceased. And ironically enough, they were declaring her deceased, but they thought something bad had happened. But could you imagine reading all that stuff while you're getting a notification like, yeah, but you got cancer. So maybe.
00:11:52
Speaker
Maybe I just would have been like, dang, that's messed up. But yeah, I don't know. I do not presume to know what kind of cancer she has. I am not an oncologist or an expert in oncology. All I know is must be in her abdominal or pelvic region. That can be colon. That can be ovarian. That could be uterine. That could be none of the above depending on, you know, how, you know, how bad it is. But I hope that she recovers well. Did y'all see that dot that they had on TMC?
00:12:23
Speaker
I saw a doc on CNN talking about it. Yeah, they were trying to talk about it. And I'm like, yo, this speculation is not ending well for people because they are eating those doctors alive on a speculation. So I'm like, listen, just for the record, y'all, I do not know what cancer she has. I am just praying for a speedy recovery.
00:12:42
Speaker
Right. Because it's really hard to talk about that because, you know, each cancer behaves differently and there's different treatments for whatever type of cancer it is. So it's really hard to just talk in general about that, you know, but but I think sometimes it's like we don't
00:12:59
Speaker
because people are in the limelight and they're famous, we kind of forget that they're human. And like they're living their life under the microscope, everyone sees, right? And I don't think I really realized like she has kids, like she probably is trying to protect her kids from what's going on, and all the speculation. And I like I actually kind of forgot about I'm like, that's true. She has young kids like they don't
00:13:24
Speaker
That's kind of messed up that they're seeing or they could be exposed to all of that speculation. And, you know, they don't know and they're kind of young and probably wouldn't be able to understand what's really going on. I mean, I have an idea that like mommy is sick, but we don't know what she's sick with.
00:13:43
Speaker
But that can be traumatizing for kids to hear that your mom has cancer on national television. Exactly. Exactly. Go to school and your classmates know more about what's going on than you do. And you're like, what? It's confusing. Yeah.
00:14:02
Speaker
Yeah. So, you know, just to say definitely I wish her the best and, you know, you definitely don't have to divulge any additional information. I think we get the point. You are going through a very tough time and I think everyone needs to respect that for her and her family. I'm going to do three topics because we have plenty of more.
00:14:26
Speaker
I just it just pops in my head. Like I said, I got I got off at 5am this morning. I got my six hours of sleep ready to go. So so I forgot that Oprah came out with a weight loss special. Was it last week? About last week, right? So essentially, during the special, she was talking about her, you know, pretty much her weight, weight loss or, you know, weight
00:14:55
Speaker
You know journey, you know when she was with um, she was Weight Watchers or Jenny Craig? Weight Watchers Weight Watchers, you know the fluctuations with that and then now she discovered the the GLP ones So, you know the ozem picks of the world essentially and actually she's been getting a lot so people who are on ozem pick I've actually been getting a lot of flack and
00:15:19
Speaker
Essentially that, oh, that's not a natural way to lose weight. Why do you guys need to do that? Just diet and exercise. That'll solve all your problems. Some of the fitness things I'm on on Facebook have also had that same sentiment. Why can't you just do this program? We lose weight this way. It fits. It's a one-size-fits-all for everyone.
00:15:42
Speaker
You know, I got to kind of, I'm just the lurker in the group. I don't really comment or post anything. I'm just like, that is just not how this works. Like some people may require the use of these drugs. You know, they have diabetes if they don't have diabetes. We found that these drugs do help very well with people that need to lose additional weight. You know, for people that may have metabolic syndrome or additional risk factors, prevent them from progressing. That's for my opinion.
00:16:14
Speaker
additional needs to lose additional weight, that just weight loss and that dieting and exercise just cannot do. So it's just kind of, I don't know why this all this, this conflict is going on. Like this is the path that she chose to lose weight and that's perfectly fine. People choose their own paths to lose weight and be healthy. And she is probably the healthiest she's ever been since she started this journey.
00:16:42
Speaker
Um, I know, you know, you guys probably deal with a lot like those Zenpix, the Zepbounds, the Legovi. Um, is there another one? There's probably another one. Um, so Majaro and Zepbounds are the same thing. Um, but there's also the non-GLP one, you know, or the non-injectable because they're not both technically GLP ones. Um,
00:17:08
Speaker
There's Fentumi, there's Contre, there's... You're still using Topamax for this as well. Yeah.
00:17:15
Speaker
Yeah, so Topamaxin, Fenturamine, what is that called? Qsemia. Qsemia. There's lots of them. Here's, you know, and people, first of all, I'm with you, Dr. Noll, stop telling people how to lose weight, right? Like, as long as there are tools out there to use, then we gotta stop shaming people on which tool they decide to use to lose weight. Because essentially what they're saying is, oh,
00:17:43
Speaker
Ozimpic and Wigovi, yeah, that's unnatural. But you mean to tell me that your 90 day drink, you know, 90 day juice challenge is a natural way to lose weight? It's, if anything, I would argue that it is probably unreasonable to use that as a tool because where are you transitioning to? Like, you know, I do not see Ozimpic, Wigovi, let me use the right terms.
00:18:13
Speaker
I did not see We Govee and Zip Mound any differently than someone decided to do the J.J. Smith's movie challenge, or to do Weight Watchers, or to do
00:18:29
Speaker
any other weight loss program, they're all tools that are trying to get you to trigger some food consciousness, to get you some small wins, right? Get some weight loss going, because if you get some people some wins, that typically motivates people to continue to lose weight, so whether it be diet, exercise, combination of both. So we gotta stop, you know,
00:18:51
Speaker
we gotta stop doing that. Like that just isn't a thing because we can't be critical of people who are trying to lose weight and then equally critical of those same people if they die of metabolic disease.
00:19:02
Speaker
So which one do you want, right? Do you want them to be pursuing a healthy lifestyle by any means necessary? That's reasonable and that's safe that their doctors have checked off and signed off on? Or do you want them to be, you know, dying of the diseases that are getting them there through this? So, you know, through whatever their current lifestyle is, so there's no one size fits all. So whoever says there's a one size fits all is completely out of touch with, you know, weight management,
00:19:31
Speaker
with chronic obesity, with obesity as a disease, with all the risk factors that come with it. Because even patients on Wegovi and Zepbown, they all have a slightly different approach to their management.
00:19:46
Speaker
Some of them are perfect. That's all they needed to do was have me, is for me to put them on it. But also the reality is, is that a lot of them oscillate up and down while on the medication, right? They'll come in one time and they're down 10 pounds. I see them again, they've gained two. I see them again, they're down four. I see them again, they've gained six.
Obesity as a Chronic Disease
00:20:04
Speaker
And so even on the medications, they're still trying to find their way. And so they're still having lots of transitions in doing it. So, you know, I'm trying not to shame
00:20:15
Speaker
Um, any patient or any person, and I try to correct my patients in the office when they're like, well, I could get this medicine. If they, no, no, no, no, no, don't do that. Don't do that because the people who are just trying to lose weight are not taking your authentic. They're getting me going. And so you take that up with the manufacturer. If they don't have enough of both on the, on the shelf, because we're not, we're not going, we're not going to do that. You know, because some of those people who have obesity are, have the potential to have.
00:20:40
Speaker
diabetes, have the potential to have heart failure, have the potential to have kidney failure, if they continue that course. And so if that gets them off that course, so be it. Yeah. I'm with you on that. I mean, these are just tools that we use to help you to be healthier, right? And, you know, shaming people for that, that's not right.
00:21:01
Speaker
Yeah. And we, you know, when we were at DC for the AFP conference, not this time, not this year, the year before last, one of the things that came up in the obesity discussions is obesity being managed as a chronic disease. So medicine, and so medicine is partly the blame, right? So medicine had a really bad habit of saying, okay,
00:21:23
Speaker
We got obesity. Let's fix it. Team on three. And we kind of treated the same way. We treated a pneumonia or an infection or something like that. Let's cheat it until all the signs that disease is there goes away. And then we kind of walk away and we say, okay, mission accomplished. But that's actually not the approach anymore. So the new literature says you got to think about obesity as chronic disease management.
00:21:44
Speaker
So just because you get the weight down does not mean you take your hands off and you walk away. So we're really managing it more from a lifestyle standpoint. We're in it for the long haul. So we assume that if you have obesity, that your obesity, whether it be controlled obesity or uncontrolled obesity, still needs to be managed, whether you are right at your target or you're 20 pounds over or you're 100 pounds over. So we're not, we have also walked away as a medical community from the idea that
00:22:14
Speaker
all we had to do is fix it. Because if you saw your potential to carry your weight at this number, you never go back. That's not true. That's not true. You will find your way back. If we take our hands off the pedal, if you take your hand off of it, take your foot off the pedal, you will go back.
00:22:32
Speaker
for sure. And you even see it in weight loss surgeries, right? Yeah. A lot of people that do like their gastric bypass, like they do it and then all of a sudden they're like, Oh, I gained that way back and then some, right? Some people don't gain the weight to the power before the surgery, but
00:22:52
Speaker
Have you ever read the literature on what they say the fill rate is? Somebody lying. Somebody is fudging the numbers. I think when I read it last time, it said that the fill rate was 40%. I was like, there's no way. There's no way. I had to be reading a bad article. You're going to maybe try to research it right now. I think that the fill rate is more like 70, 80%. For the gastrectomy, the sleeve, all that stuff, the Roux and Y.
00:23:23
Speaker
I think mostly for probably from the sleeve, right? I mean, you can. That's probably, well, that's why, I mean, before you actually go in to get the bariatric surgery, that's why they have you do a behavioral health consultation because you can't, you can't, so getting the surgery is not just a one, it's not just one and done. Like you have, it's literally that you need to learn the habits of eating properly when you have a stomach that's like half its size.
00:23:52
Speaker
because you can out eat those procedures and you can gain that weight back. Like it is very easy to do so.
00:23:58
Speaker
For sure, but I think a lot of the issues too, I think now they might be changing that is after you had the surgery, you're seeing for like a couple of months after, and then they're like, okay, goodbye, off to your own devices, right? Like figure it out. And I think that's kind of how people get lost in like getting the way back because they kind of are a little bit lost to follow up and just go back to their old ways.
00:24:26
Speaker
Well, then I mean, in a real world, like I think a bariatric clinic should have access to like the weight management, kind of like a primary care physician, like a weight management specialist that will be continuing to manage you even after you get the surgery. I get it. The surgeon does the surgery, you know, their part is done.
Understanding Dementia
00:24:45
Speaker
And now the rest is kind of up to you to kind of maintain this weight loss and to make sure that you don't gain this weight back. But I think having that extra tool.
00:24:53
Speaker
of having a, um, a specialist that it's, you know, does weight loss management after you get the surgery, or even after you start the, uh, GOP ones that can actually set you up for more success and more long-term. Uh, I don't want to say gains because we want the opposite of that, but like the long-term effects of, or benefits of the surgery or the weight loss medication, because that's.
00:25:18
Speaker
Yeah, when we're left our own devices, and we don't develop those habits, and yeah, that's, it's very easy to break those habits and get back into an old routine. But I think if we had that set that infrastructure set in place, then we see a lot more success with it. I actually wonder how surgeons are doing various researchers are doing now with these the kind of the influx of all these drugs now on the market. I wonder if they're doing great, because the insurance companies don't cover them.
00:25:45
Speaker
They cover weight loss surgery. They don't cover, um, we, they don't cover, uh, zip bound and we go V. But they'll cover the surgery, which is like $1,000 more. Yup. Yup. Well, I think it's because they're spending more money in the front end to spend less on the back end.
00:26:02
Speaker
But the irony is that I got a lot of post surgical patients that are on, they're still on the same GOP one. So like, it's, you know, now you read the chart, like they do follow them longer now than they used to. But now since I read the chart and I see like, Oh, you're, you're back at weight loss clinic and you're taking Ozinfic. Yep. Yep. After you had the surgery. Exactly. I know.
00:26:26
Speaker
But I guess they just don't want to keep paying for the medicine because there's no particular time to get off of it per se. You're supposed to be on it. Because we're treating it like a chronic disease, just like with hypertension. You're on medicine. You get off the medicine, then your blood pressure gets high. But as long as you stay on the medicine, you're good. Everything's fine.
00:26:49
Speaker
So the one big upfront cost, like the insurance company will know, okay, we're going to recoup our stuff with that, but with the, the medicine over long-term, then there's, that's, they're actually losing money on that in some way. I think that, I think that's kind of their thinking, but at the same time, they're still spending more money. They still spend a lot of money. On insurance companies. Cause my God, this is just the worst.
00:27:14
Speaker
Okay. All right. So I don't want to steal Dr. Chris's thunder. So the trending topic fits in very well with their main topic. So we are going to transition. So Dr. Chris, take it away. Oh,
00:27:28
Speaker
Okay. I thought you said you had three. I know she did. She passed the baton. She passed the baton and I missed it. I dropped it. Going back trying to find it.
00:27:47
Speaker
She gave you a look, a no-look pass, but you was not looking like. Right. I was not looking, drop in late. We lost the relay. Lost the relay. Lost the relay, y'all. Just lost it. Straight up. I know it's March Madness, but you can't be doing them no-look pass unless you know we watching. Right? Right. Now we didn't miss the bucket, then the bottom of another bounce. I know. It's just turnover. Right.
00:28:11
Speaker
I'm all the way messed up right now anyway. So the topic I was going to talk about is dementia. And I thought it was an interesting topic because I feel like, well, I guess in our clinic, I see it a lot. I see a lot of, especially now that there's a lot of
00:28:36
Speaker
you know, the baby boomers are getting older. So a lot of times like, um, we're seeing the geriatric patients and they might have dementia and the caregivers are stressed and all, you know, all of these things are occurring. So, and especially, I think recently there was, um, was it Wendy Williams that had her special?
00:29:00
Speaker
And she was diagnosed with a form of dementia and just watching. I didn't even watch the whole thing. Did you guys watch that? I saw snippets of it. Yeah.
00:29:13
Speaker
It was pretty sad. And so then I just wanted to kind of touch on it and talk about it a little bit, talk about what it is, what happens, risk factors, how we treat it, and some things that we can do to help people who have it, right?
00:29:39
Speaker
So just a few facts that I got from the World Health Organization. So I say that currently more than 55 million people have dementia worldwide, over 60% of whom live in low and middle income countries. And every year there are nearly 10 million new cases. So
00:30:01
Speaker
Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependence among older people globally. And they said in 2019 Dementia costs economies globally 1.3 trillion US dollars. Approximately 50% of these costs were attributed to care provided by informal carers like family members, close friends,
00:30:25
Speaker
provide an average of five hours of care and supervision per day. And it also says some key facts that women are disproportionately affected by dementia, both directly and indirectly. And women experience higher disability adjusted life years and mortality due to dementia, but also provide 70% of care hours for people living with dementia. So when I was reading that, I was like, oh, that's,
00:30:51
Speaker
It's interesting. I didn't even realize that dementia was the seventh leading cause of death. I didn't realize that. I mean, I see a lot of it, but you know, um, dementia is scary. Let me tell you all the things I prayed to God, never had dementia. I find dementia to be one of the most frightening, um, disease processes that you can ever witness.
00:31:19
Speaker
Yeah. Yeah. It's rough. It is rough because it's just a, uh, it can be a gradual or really fast, progressive decline. And a lot of times there's, I mean, we have some things to maybe try to prolong it, but there's not that much you can do. Yeah. Right. And I think that's the scary part about it is that, you know, it's just.
00:31:45
Speaker
you're just seeing this person that you know become somebody that you don't recognize, right? And it's not their fault. And it's just not their fault, right? And like the personality changes and everything. You know what, something you just said surprised me though, that you said that like family and friend contribution accounts for five hours a day, I am actually shocked because I thought it was more than that. Because the amount of work we do in the office trying to get resources in the home,
00:32:13
Speaker
It feels like they're making up way more than five hours in the day. It has to be more than that. I think that's a gross underestimation of that. Probably so. Yeah. I wonder if they're counting if everybody's at home.
00:32:30
Speaker
You know, in his bedtime, does that count? You know, does it, you know, obviously, you know, cause in my mind that counts because a lot of families like that I talk to are doing things with like somebody got a night job and somebody has a day job, right? So somebody works night shift, somebody works day shift so that you can sleep at the house when the other person is gone. When I get to that person is sleeping, but you're still there to make sure that, you know, mom, dad, auntie, uncle, whomever.
00:32:57
Speaker
doesn't wake up and start the room. Even though they're resting, they're getting sleep, they're waiting for the day, they're waiting for the switch off to go back to work. It doesn't get covered. I think that's the biggest shock. I'm not going to steal your thunder though, because you may talk about that, but the 24-hour care thing gets tricky.
Types & Management of Dementia
00:33:23
Speaker
So dementia is just a term that they use to describe a group of symptoms, right? So basically it is caused, it can be caused by damage or loss of nerve cells to the connections in your brain. So many different diseases can cause dementia. And basically it affects your cognitive and can affect your social skills. And it can be like a gradual decline over time, right?
00:33:53
Speaker
So there are certain risk factors for dementia. Age, 65 or older, hypertension, high blood sugars, being overweight, obesity, smoking, alcohol use, too much alcohol use, being inactive, being socially isolated, and depression. All of these are some of the risk factors of dementia.
00:34:20
Speaker
Age is known to be the strongest known risk factor for dementia, but it doesn't mean just because you get old, you're going to get dementia. So I think that's an important thing that people should understand because it doesn't mean just because
00:34:31
Speaker
like you're 85 years old, you're going to get dementia, right? Cause I got some 90 year olds, a hundred year olds that could run circles around people that are in their twenties, you know? So I do though. Right. So it is not an inevitable consequence of aging, right? And it doesn't, it doesn't exclusive exclusively only affect over the older people. It can affect younger people too. Cause there is, um,
00:35:01
Speaker
there is a early onset dementia. And that's when people develop it much earlier, probably like in their, I think the earliest I usually see is like in their 40s or 50s maybe, depending, they can develop it then. And sometimes of course there is some genetic predisposition, genetic predisposition. It's late, I'm trying to,
00:35:30
Speaker
yes that meaning that you can have like higher risk of developing dementia if it runs in your family but that's like they said that only accounts for like about nine percent of cases so it's not like a really big number right so some of the things that can happen um so basically dementia now
00:35:54
Speaker
It's really how we diagnose it. I'm putting in an air quotes. It's really called mild cognitive impairment. So we normally diagnose it as that because they're, as most diseases, they're different grades to it. So with dementia,
00:36:15
Speaker
some of the symptoms that you can end up not recognizing faces, objects, and people, memory loss, especially short-term memory loss, can't remember like everyday objects, can't
00:36:30
Speaker
make, know, can't communicate with others very well, have a hard time finding words to communicate a thought. Can't perform like simple tasks that you normally used to perform, right? If you used to could just can't do it like that anymore. You can't dress yourself very well anymore. Something that you
00:36:51
Speaker
already learned how to do and were able to do from before. A big thing is loss of executive function. So hard for you to plan ahead, sequence of events, and that's very difficult for people who have dementia.
00:37:06
Speaker
And in the office a lot of times, Amy Jo can say, we do little cognitive tests to kind of screen. It's more of like a screening tool to see like, oh, let's say family member comes in and like, oh, I think grandma has dementia. She's having some trouble remembering things and doing things. So then we do these little mini screens to kind of, these little tests that we do to kind of see like, okay, maybe there could be something going on, right?
00:37:36
Speaker
And I thought about one of the tests that we do, we have them draw a clock, which I thought is very interesting. You never really think about it, but how you draw a clock, right? And that also tests how someone plans ahead and thinks in sequence to do something, right? So if you actually really think about how you draw a clock, you draw a circle, right? You do your 12, your six, your three, your nine, right? And then you put the numbers in. But people who have this problem,
00:38:05
Speaker
Have problems with memory or dementia Can't have a difficult time Doing the clock just thinking about what's the next step to do? Yeah, and I've seen people you man. I've seen yes, it is so painful because It's interesting to watch because they're trying to draw this clock and their brain is betraying them and they are there is an awareness like
00:38:33
Speaker
Yo, you are failing me right now. Right. And they are like working it. And they're like, some people just be like, this the clock. I don't know. But some people are like, wait, no, that is not it. That is not it. That is what is going on. And you can't do anything. You just sit there like, hmm.
00:38:54
Speaker
Yeah, it's, it's crazy to watch. Yeah, it's, it's, it's crazy. Like even when you're testing, so when people come into the hospital, you know, you kind of seen so many, the place where I work, I think like it's the highest concentration of centurions or was it a hundred year olds like in the country. So we get a lot of dementia cases coming in there. Um, so you can kind of pick up on, you know, something,
00:39:24
Speaker
you don't know it immediately off the bat, because people with dementia, they're not always like, I'm sure in the movies, they portray them as, you know, this old person is drooling in the corner, which that is not dementia at all, that can be advanced end stage dementia. And that's where we probably need to start, actually, you know, way before that start having that conversation. But you know, if people with dementia, they can be fairly lucid, like they can have a full on conversation with you, and then maybe five minutes goes by, and then they'll ask you,
00:39:54
Speaker
Oh, you look familiar. Nice to meet you. Uh, were we talking about something? Right. You're like, yeah, this off here. So, um, so it's, it's very, um, it's very profound kind of their memory deficit. And also like, even their concept of just time in general, like you, part of our assessment in the hospital is we ask you about your name, your date of birth.
00:40:22
Speaker
Um, where you are, what, you know, time of day it is, you know, the month, the year. And people with dementia will say with their full chest, Oh yeah, it is 1932. And I'm like, no, man, not your birthday. Like, yeah, no, it's, it's 1932. And I'm like, okay, so who's the current president? And they'll say something like Carter. Yeah. They absolutely will. And you're like, okay, I don't think we're.
00:40:51
Speaker
And then we get a lot of cases before they're formally diagnosed, but you can definitely make an inference that, yeah, this is likely a form of dementia and you need the formal neurocognitive testing to be done once you leave the hospital for your other problem. And that can be done, again, like Dr. Chris said, like in the primary care clinic, or if you have a neurologist that you see, they can do it real easy, typically in their clinic as well.
00:41:21
Speaker
Yeah, and I just also wanted to note, like a lot of people come in, I'm sure Amy Jo, you get this a lot of times too, that people come in and they're like, oh, I think I got dementia. Cause you know, I just forget things a lot and I just want to get tested to find out if I got dementia. And it's just like, that's not really how it works, right? Because everyone can forget things. Like if you got a lot of things on your mind, you're not getting enough sleep, depression. That's another thing that can like,
00:41:49
Speaker
mimic some of the signs of dementia, because you're depressed, you're just not processing things very well. So some of those things can happen. But a lot of those times, like if you misplace your keys, like, I think everyone has misplaced keys and can't find or, or saying something and then be like, Oh, man, I forgot what I was gonna say.
00:42:10
Speaker
I was gonna say, but it comes back to you, right? Pretty fast. Like, people who have this problem with dementia, it doesn't really come back to them that fast. They really gotta, like, think about it. And sometimes it doesn't even come back to them at all, right? And in a lot of times, like, another thing is, like, if you're used to going someplace, the same, like, you go the same way every day, you're used to this, you know how to get there. And then, like, people with dementia, they can go someplace and don't recognize
00:42:38
Speaker
where they've been, like where they are at all, but they've been going to this place for years and lost and have no clue where they're at. Right? Yeah. And that is very, um, it's a big thing that in dementia, you just don't have, it's, it goes away. I mean, that's how we form relationships. We form, um, connections, we form,
00:43:02
Speaker
recognizing areas, landscapes, people, faces. The neuroplasticity is a big thing of research in dementia community. And that is one thing that definitely goes out the door once you get into the more severe stages of dementia. Yeah. And then you also kind of like end up not recognizing people that you know, that you see all the time. Don't recognize your loved ones, you know.
00:43:26
Speaker
There's some people who have dementia even in the later stages that could still recognize some people, right? But a lot of times they end up not recognizing, like, let's say the someone who's been married with the same person for like 50 years and don't recognize like their husband, right? And it's just like, what? How did that happen? So that's, that's the worst part. That's, I've seen couples, they've been together for like 50 years and they
00:43:56
Speaker
bring their spouse in and they have no idea who that person is. It is so heartbreaking to see. It's a crazy disease. It's really tough. So basically how you determine the severity of the disease is based on
00:44:13
Speaker
some of the activities that you can do. So we kind of break them up into basic two activities of daily living and instrumental activities of daily living. So your activities of daily living are like eating, bathing, grooming, walking, dressing yourself, transferring, toileting. Like, can you do those things, right? If you're having difficulty with it, depending on how difficult, how many difficulties you're having, that depends on the severity, right? Which are instrumental
00:44:43
Speaker
activities, managing finances, medications, food, housekeeping, laundry, transportation, taking your meds. So some people like they can't manage their money, they forget to pay their bills, you know, and that's a big thing, right? They can't pay their bills on time, they're messing that up. So that's when you got to really think about maybe they need some supervision, somebody to help them.
00:45:12
Speaker
You know, things like that. And, and I think one of the things also know is that when you're the family member and most time it catches everybody off guard because a lot of the patients are living alone. They have been high functioning and high functioning is regardless of.
00:45:31
Speaker
education, like some of them may have a high school education may not and they are articulate, they are smart, they have been they have been doing their thing. And you got to catch them. Actually, like, you got to get real suspicious on it, you got to catch them actually in the act.
00:45:49
Speaker
And trying to assess some of this gets very, very tricky because people who are well-read, who are well-educated, well-cultured, well-experienced will be slippery and they can cheat the system.
00:46:06
Speaker
So, you know, you'll have, you know, and it happens on both ways, right? You'll have me as a doctor saying, no, they good. They, you know, they ain't here doing fine. The family members going, uh-uh, no, listen, they tricking you right now, doc. That's not, that's not who I'm seeing. And then on the verse end, there's sometimes where I'm like,
00:46:24
Speaker
Um, so y'all want to talk about dementia? And the family is like, no, they're good. Like, oh, we were on our way here, and they were just, you know, doing it. You know, it's easy to brush it off with like, well, I mean, everybody forgets something sometimes. But what will happen is, is that it'll be kind of this consistent decline, and almost always somebody else's fault. Somebody moved my checkbook so I can't pay bills.
00:46:53
Speaker
they changed my password and now I'm locked out and I can't get back in anymore. And so that's why I didn't pay it online. And so while I do want family members and, you know, to investigate thoroughly and take them at their word. But if you start to notice that this is happening more and more often, that's your cue to be like, it might be time to take you in so that we can do some assessments. Yep. Yeah. Okay.
00:47:20
Speaker
And so there are different types of dementia. So the most common one that everybody is familiar with is Alzheimer's. And this one is just really more of a gradual decline and loss of function, right? So you really kind of see it over time. So it's kind of hard to pick up kind of in the beginning, but you know, as it goes on, and it gets worse,
00:47:44
Speaker
it becomes way more evident that this person needs help and can't live by themselves and needs assistance to do things.
00:47:56
Speaker
Another type is called is vascular. So basically what the vascular one is can occur from strokes, multiple strokes, that's basically not having enough blood in blood going to the to the brain, right, and causing damage damage to the brain, right, you're having like, constriction of the vessels and depending
00:48:20
Speaker
on the area of the brain, it can affect, it can affect memory, it can cause some issues. So usually what you see, they always say it's kind of like a stepwise decline. So you kind of see it in a stepwise fashion. Like first this happens, then like first they have maybe a little trouble with memory, then they have issues with like getting the words out then. So it's kind of like that. And basically you kind of just treat the underlying issue, right?
00:48:48
Speaker
So it can be hypertension, AFib, like just disruption in blood flow to the brain that can be causing that, right? Another type is Lewy body, which is not very common.
00:49:03
Speaker
But basically this one usually has memory loss and it has movement issues. The most interesting one about that one is a lot of times people can have like vivid hallucinations. So they can just be, they can see things. But a lot of times they're not even bothered by that. They'd be like, oh, look at this black cat that's just over there. You don't see it there. And they're just saying it's right there. It's just, you see it? It's fine. They're not even bothered by it, right? And they,
00:49:32
Speaker
But it's not very common. That one is not very common. Now, the one that most people are hearing about in the news, especially from like Bruce Willis and like with Wendy Williams is more of the frontal temporal dementia. And all that means is that it's just they're just talking about the area of the brain that it affects. And usually what you see is that you have a change in personality or mood. So a lot of times people like
00:49:58
Speaker
They have kind of like no filter. They don't pick up on social cues very well, and they're just doing things that are inappropriate. So they can be in a social setting and decide, okay, I'm just going to take off my clothes just because I want to take off my clothes. I'm just going to do that, which is not appropriate. How does everybody like to get naked? That is the part. I don't know. I don't know.
00:50:18
Speaker
And guess so, because listen, every confused, not everyone, but if you are confused at any point in time, the chance that you're going to get naked jumps to like 90%. It's just bound to happen. The one thing, every time somebody's like, oh, somebody is so confused, I can remember as a resident, like, please don't let them be naked by the time I get to this room, because I just let them at least have one account or something. But it's something about being naked.
00:50:46
Speaker
Yeah, so basically it's just like that inhibition is gone, right? So you go to certain things and you're like, oh, I'm not going to do this because that's not right. You shouldn't do that. These people, they lost that. So they just say whatever comes to their mind, do whatever they want, right? And so that's what happens with that.
00:51:10
Speaker
There are not too, I mean, there are some treatments out there, but the treatments that we have, the medicines that we use for dementia are really just to help to prolong the inevitable, in a sense, to try to slow it down. And it really kind of all depends on when you catch it.
00:51:28
Speaker
I think when you catch it early, it seems to work better in my experience than catching them in the later stages. And it's kind of like sometimes you might see a difference and sometimes you don't. What do you think Amy Jo? I agree. Um, and I don't know. I don't actually know if the literature supports that. I think catching it early makes us feel like we have better outcomes because we're watching the progression for a longer period of time. I actually don't.
00:51:57
Speaker
know that the literature says that early initiation of treatment prevents dementia or prevents worsening. The prevention of dementia actually comes well before the dementia hits, right? So prevention of diabetes, prevention of obesity, prevention of metabolic syndrome, improving your supplementation,
00:52:25
Speaker
Some of those things have known to improve outcome, but the medicine actually doesn't change the progression. You either are going to work on ways to avoid disease, or once it's set in, you're going to follow the course. A lot of the medications we also use are for behavioral issues, so things like extreme agitation that you get with sundowning. Usually your doctor will put you on a low dose Seroquel, which is an antipsychotic.
00:52:54
Speaker
Um, and sometimes they may use like some of the stronger stuff if the agitation episodes get really, really bad. Like I saw a 90 year old, you know, put up fisticuffs with one of our big nurses at her hospital, you know, she, she was winning the fight. So, you know, so, so unfortunately, you know, in that case, you know, we may say it's all, you know, at least grandma got her strengths, but.
00:53:18
Speaker
in situations where you kind of need them to be calm and to help take care of them. Having them be agitated and trying to fight everyone that comes into the room is actually a detriment to them. So that's usually where the anti-psychotics will come into play, like Haldol, Seroquel, a Geodon, all those things. Yeah, I agree because the medicine in a sense,
00:53:47
Speaker
Based on my experience, it's basically subjective findings. You put them on the medicine and you ask them, how do you feel to know if it's helping or not helping? There's no really way to monitor it. There's no blood levels that you're looking at. It's just basically asking them, hey, is your function OK? Because if it's mild, it doesn't necessarily mean that
00:54:14
Speaker
If the medicine is necessarily working per se is just probably because there's just still in the miles to stage and they can still do things, right? So I very much agree. But a lot of it is like they say, you know, staying active, like we're saying ways to prevent it from happening. But let's say you do have some mild cognitive impairment, right? So what do you do? Right?
00:54:38
Speaker
staying active, writing things down to try to remember, to try to make those connections, right? Of course, not smoking, not drinking, eating healthy, staying active, being social, don't be isolated, right? And I think that's a big thing. Social isolation makes it worse, right? And even people who do have
00:54:59
Speaker
like more of the severe, more of the moderate to severe cases of dementia, a good thing to do is keeping routines with them, right? Like they get all off when you switch the routine, right? Like just keeping routines, trying to keep them as comfortable as they can, try to get them out, try to get them to do things.
Preparing for Dementia
00:55:22
Speaker
Yeah.
00:55:24
Speaker
Same environment, now it's not the time to move furniture. That is a really bad mistake. Because somebody is going to have to move in, right? We've got to pull the family together. Who's going to live auntie such and such or grandma this or mom that? And so you get somebody who moves in, and I get it. Now that they're moved in, they are trying to
00:55:47
Speaker
Establish a new environment for themselves right they now live here too, but I would be careful with like moving furniture Moving dishes around you know changing pots and pans not that they will be cooking because Cooking is the one thing that I tell people to take away from them right away. I've had people say really casually like
00:56:11
Speaker
Oh yeah, that must've been where that hole in my gown came from. I must've said something on fire cooking. I'm like, I'm sorry, what? And they're saying it for the first time and everybody in the room was just hearing it and you're like.
00:56:23
Speaker
Okay, okay. Y'all take the stove away from there, please, I thank you. So, you know, all of that kind of stuff is something to think about. So, typically, the same routine, the same people who come in and out, the same, you know, setup of the house, that typically helps them, you know, routine dinner times, routine meal times, even if they don't want to eat, you know, kind of having some of that routine really helps them.
00:56:53
Speaker
Did you run across the article about the dementia communities? Yeah, those are actually really cool. Those are so cool. I didn't like Sweden or something and they have one and they actually have a dementia cafe somewhere in like Japan where they actually have people with dementia that actually will come and serve you. But the caveat is they'll take your order, but they may not remember what you ordered. So you'll get a whole different meal.
00:57:20
Speaker
You just go with it. Yeah, it was very cute. But it kind of it kind of fosters that sense of, you know, they're not isolated. They're doing they're doing a mental exercise to keep their brain active. But the dementia communities are something a little bit bigger. I believe that's where they actually have a little town where it's kind of like assisted living, but like on a larger scale.
00:57:46
Speaker
Yeah. So like all of the grocery stores, the mail, there's like, there's a grocery store, there's a post office, there's a church. There is, you know, all these things, they're all staffed by like healthcare providers, but they, they are going to the store, right? I'm going down the street to the store. Cause this is where I live. I always go to some local grocery store. They can pick up food items, stuff like that. They can make exchanges, but it's all, you know, closed in. Like you cannot leave off the campus.
00:58:14
Speaker
And it's a gigantic community built for them so that everything is always the same. Yeah, that's a very good idea. Yeah, and it also helps them still have the independence because I think that's a big thing that they struggle with, right? A lot of times they don't want to lose their independence and sometimes
00:58:33
Speaker
they trick you, right? Because they don't want to be put in the home. They don't want you to know that they're having trouble, right? And so that's a good idea to do that, to keep people active and social and having their own independence. Yeah.
00:58:54
Speaker
The independence is the worst part. I will have conversations with people on the front end of their dementia and often prefaced with, we're going to have this conversation again, except for it's going to be a little sad because you're not going to remember that we talked about this at this time.
00:59:13
Speaker
But if there's any consolation, I'm going to tell you now, what I'm going to tell you then, and so that maybe if we lay it in your brain now, you will know that I mean you no harm, your family means you no harm, and we'll be doing things down the line to keep you safe.
00:59:31
Speaker
And I have now been in practice long enough where you hit that road. And so I've had to say, hey, remember when I told you a couple of years ago or remember when I told you six months ago that we were probably going to have to have this conversation? So we're getting ready to have it. It's now time to give up the house. It's now time to let somebody move in. It's now time to say, I really don't think that you can drive anymore. Or I really don't think that
01:00:00
Speaker
you can live alone. And so that becomes a thing. Are you gonna talk about things that people need to do? Families, listen, families. Once you get the slightest inkling that your loved one may have cognitive dysfunction, may have some form of dementia,
01:00:27
Speaker
Get them to give you their papers or make copies of them. Get them to put on record, whether that's something that you have them record. It still needs to be backed up by legal documentation about where their documents are, who they want to take care of them, who they really don't want to live with.
01:00:45
Speaker
they think they want to live with because of course the time you're asking everybody's going to be like, no, I live by myself. Okay, fine. Okay, Miss T, but who you want to live with for real? Because I think, you know, even though you have cognitive decline, you still have a lot of personality in there, right? And so if their least favorite child, I know they suppose all, you know, you're supposed to love all your kids the same, but y'all got favorites. Okay.
01:01:10
Speaker
So if the kid that you get along with the least is the one that ends up moving in your house or the house you got to move to and you think, this is not what I would choose for myself, dementia doesn't always prevent you from acting on that feeling. So even though the brain is failing, it's not all gone. There's always something. And so you'll have a patient that has now been forced to live with somebody that they would not have picked for themselves.
01:01:38
Speaker
And you'll have us trying to put them on so much quetiapine that they're just completely snowed all day. We're trying to figure out what's the issue. And then you later learn that, oh, these two have been arguing since they were 10 years ago. They've had arguments. I'm like, oh, well, that makes sense. That's why this is happening, right? Oh, that's why all these things are going on. So I would tell you to sit down and have conversations with them.
01:02:07
Speaker
What is it that you want? So how can we make your life the most comfortable when you cannot make decisions for yourself? What does that look like? What decisions do you want me to make? What does it look like as we structure your day, where you live? Where do you feel the most safe? Where do you feel the least safe? Is there any secret that you need to tell me right now that's going to matter and how I make these decisions? Go ahead, I spill that now.
01:02:35
Speaker
If you don't want to spill it, write it down and put it in a safe somewhere and give me the cold. So a pun, you know, it really, you know, give me something, right? You want to put all that stuff together and you as the family, I have put this morning out there for many families. Nobody ever believes me until it's too late. Um, so maybe I'm not saying that the right way. Listen, you, I know that hearing from a doctor or hearing from a neurologist or even hearing from the patient that they have dementia, you're still looking at this.
01:03:04
Speaker
really independent person that you probably love and admire and you've never seen them have a bad day in life. They have been your hero, your she-ro, they have always gotten the job done. Once we are telling you like dementia is coming, you do have to make a decision about where your sacrifices are going to be. Because I find that the families always come back to the table going like,
01:03:30
Speaker
Man, mom doesn't remember anything. So what are we gonna do next? We need to get all this stuff in place. We don't have any idea who's gonna stay with her. We don't have any idea who's not gonna stay. Well, I work, nobody lives here. Well, we're gonna put cameras in. Don't get caught off guard. Even if you don't act on the things, you need to have a solid plan. Not just, well, if it happens, I guess we could try this. I would go ahead and say, no, we got an implementable plan that we're gonna put in place.
01:04:00
Speaker
Once we get the sign, once we get the word that is going down, fine. We prepare for this and here's what it is. I think when that, that when families get caught off guard, it causes so much stress because y'all are working. You have young kids sometimes and now you got to figure out who's who got to quit their job or who's got to change their shift or who's going to take care of the kids. I can't leave my house because I got this and now you've got siblings fighting, all this kind of stuff. It's not worth it. Make the plans.
01:04:27
Speaker
Make a plan. That is very true. The living will written up and there needs to be a healthcare power of attorney and a financial power of attorney. Like those three basic things, at least to get you started with the plan going forward. And then at this, this should actually be a talk you should have before. I guess this point, but how out of care works really well in this type of situation and kind of preparing you for, you know, what's ultimately going to come down the road.
01:04:57
Speaker
know, palliative care is not for, you know, dying people because a lot of dementia people are not dying. They're having a loss of their executive function and their independence. But you know, the complications that come with having dementia are usually what, you know, does them in in the very end. So having that palliative care plan put in place, you know, with the specialist that does it can save you guys a lot of
01:05:25
Speaker
you know, a lot of, you know, mental acrobats and trying to figure out, Oh, did mom really want this? Did she really want to be on life support? Like, does she really want these shocks to her heart? Does she want CPR or does she just want to go peacefully? And then that's, that is a decision you guys do not want to make in the hospital, in the ER at like four in the morning. Um, you know, it's, it's just, that's not, that's a situation we all want to avoid.
01:05:53
Speaker
Yeah, those are definitely important points. I also wanted to, um, thank you, Amy Jo, for bringing that up because that is definitely a valid and important point. And I also wanted to say that, um, I don't know if you get this too. A lot of times family members want you to write a letter saying that the, because they have dementia that they can't use their bank account or, or things like that. And we can't really write letters like that. That is, that is trying to, you know, you have to,
01:06:23
Speaker
go to a judge to determine competency, if they are competent to handle their money and do things.
01:06:29
Speaker
what we can determine is capacity, meaning that we can determine whether or not they can make medical decisions for themselves. And do understand, like people who have dementia, they kind of go in and out. So it's not like all the time, depending on what stage you are, this is not all the time that you are not loose if you don't know what's going on. A lot of times you understand what's going on. You might forget that you had a little conversation five minutes ago, but you still understand
01:06:56
Speaker
who you are, you understand what medical conditions you have, you understand some medicines that you need to be taking, maybe you don't remember all of the names of them, but you do have an awareness of what's going on, right? So I think that's an important thing that I wanted to mention because I get a lot of calls from patient friends like, oh, can you write a letter saying that, you know, because grandma has dementia, she can't, she can't access her bank account, so we can access her bank account. I'm like, mm-mm, can't do that.
01:07:27
Speaker
And just so you know, um, this gets into, you know, I'm not the, I'm not a financial expert. I do not pretend to be one. Yep. Most of us I've learned from working with you all is that, um, you can't just show up, move the assets from, from, from their name to someplace else and then put them in a home.
01:07:51
Speaker
and not have those assets assessed because what's going to happen is they're going to want to see what assets have been in their name for the past five years. So this is why I'm saying like the first time you get any inkling that there might be some dementia, that's the time to move the assets because once you're like, well, we want to put them in, we want to, we're going to put, you know, mom or dad or uncle or grandma or granddad in the home, but we don't want to have to give up the house as collateral.
01:08:19
Speaker
you may not be able to avoid that if the first time you moved the house out of their name was six months ago. I think it has to be five years before that or else it will still count as income that should count in how much you're going to pay to put them in a home if that's what you choose to do. Now, some people say that's not an issue because we're not putting them in a home and that's fine, but some people have no choice, right? You know, I've had families where
01:08:44
Speaker
Nobody lives in town. Everybody lives out of town. And patient is adamant that they are not leaving, right? And everybody's scared that they will not do well if we force them to move. And I think that that is what it is. But that also then means that you gotta put them somewhere. And these people want their coins, y'all. And a house is a great coin because it's an asset.
01:09:09
Speaker
So when you think about, you know, try to figure out how to, you know, navigate those things while still maintaining assets and, you know, and in black communities, those assets were hard earned. So I get not wanting to give up that house. It took you a long time to put that house in the family. It holds sentimental value. You're not ready to give it
Closing & Announcements
01:09:28
Speaker
up. And I understand, but it just stresses the importance of, you know,
01:09:33
Speaker
Once these things start to happen, you need to start making moves. And that's challenging because that takes a lot of conversations. And in the moment that you need to make those decisions, those financial decisions, you're asking somebody that's still within their mind, that still has a lot of independence to them and a lot of independent thoughts to give up stuff early. So there's a trust issue that's there. You've got to trust that the person you're turning your assets over to is not going to,
01:10:03
Speaker
misuse that line of trust. It's so much. It's so much going on. I just learned it from you all walking through these things. And I'm like, wow, there are things that I only know now from observing families that I would not have even thought of until then. And that's even being a physician and listening to the lectures and listening to social workers. There were things that came up that I thought I was not ready for that. I didn't even think about putting that in place.
01:10:29
Speaker
I think that's about it for the topic. I don't know if there's anything else anybody wants to add. That was an excellent topic. That was a good one. Claps, claps, yay! I'm glad you guys liked it. I thought it was important, you know, because like we see it a lot. Yeah.
01:10:45
Speaker
I don't envy the person that's got to cut this down because we've been talking. You should probably say the question for another episode. I will. There is a great question. I'm not going to say this person's name, but I see your email listener. And I know you've been rocking with us since season one. Shout out to you. You are outstanding. Yes, we see you. We hear you. We love you.
01:11:11
Speaker
So I am going to do a couple things. I will make sure that your question gets read on the next episode. You had a two-part question in case you didn't know who I was talking to. And I will change your first question into an episode. So we're going to do an episode on that question because you've got lots of questions and I want to make sure that we
01:11:31
Speaker
get you the information that you need and hopefully it is helpful. And then the second part of your question, I will read as a question and we will try to get that answer for you. So, um, sorry, we've been long winded today. Um, we didn't have Dr. Sunshine cracking the whip on us this time, but, uh, she'll be back. She'll be back y'all. Um, I know.
01:11:53
Speaker
I know, it can't, she'll kill us. So we're gonna cut it down and we're gonna squeeze it in. So we will put it down. Cause we've been making our mission to keep it, you know, under a certain time. But listen, it's good to be back y'all. Thanks for rocking with us. I know we've been a little sporadic, but hang in there. What else do I wanna say?
01:12:14
Speaker
Oh, shout out to my husband who's turning 40. Happy birthday. Um, we're gonna, you know, do some fun things. And so, uh, those, he gets all my chocolate kisses these days, but chocolate kisses to him for a happy 40th birthday. So yeah, how sweet. All right, y'all.
01:12:38
Speaker
So for the podcast, chocolate with a side of medicine. Got it right. You can find us at www.thechocolatemds.com. Our website, you can post your questions there. Keep a lookout for any speaking engagements that we may have. Feel free to follow us. Handle is at the chocolate MDS.
01:13:04
Speaker
on Facebook, Instagram, and Twitter, where we post little juicy social media tidbits and also reminders for upcoming episodes, which usually come out every other Wednesday. So it's nice rocking with y'all. We'll see you guys again. And that's it. Bye, guys. Bye. Bye.